Josephs Keith A, Koga Shunsuke, Tosakulwong Nirubol, Weigand Stephen D, Nha Pham Trang Thu, Baker Matt, Whitwell Jennifer L, Rademakers Rosa, Petrucelli Leonard, Dickson Dennis W
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA.
Free Neuropathol. 2023 Dec 8;4:22. doi: 10.17879/freeneuropathology-2023-5192. eCollection 2023 Jan.
TAR DNA binding protein 43 (TDP-43) pathology is a defining feature of frontotemporal lobar degeneration (FTLD). In FTLD-TDP there is a moderate-to-high burden of morphologically distinctive TDP-43 immunoreactive inclusions distributed throughout the brain. In Alzheimer's disease (AD), similar TDP-43 immunoreactive inclusions are observed. In AD, however, there is a unique phenomenon of neurofibrillary tangle-associated TDP-43 (TATs) whereby TDP-43 intermingles with neurofibrillary tangles. Little is known about the characteristics and distribution of TATs, or how burden and distribution of TATs compares to burden and distribution of other FTLD-TDP-like lesions observed in AD. Here we characterize molecular fragment characteristics, burden and distribution of TATs and assess how these features compare to features of other TDP-43 lesions. We performed TDP-43 immunohistochemistry with anti-phosphorylated, C- and N-terminal TDP-43 antibodies in 20 high-probability AD cases and semi-quantitative burden of seven inclusion types within five brain regions (entorhinal cortex, subiculum, CA1 and dentate gyrus of hippocampus, occipitotemporal cortex). Hierarchical cluster analysis was used to analyze the dataset that consisted of 75 different combinations of neuropathological features. TATs were nonspherical with heterogeneous staining patterns and present in all regions except hippocampal dentate. All three antibodies detected TATs although N-terminal antibody sensitivity was low. Three clusters were identified: Cluster-1 had mild-moderate TATs, moderate-frequent neuronal cytoplasmic inclusions, dystrophic neurites, neuronal intranuclear inclusions and fine neurites, and perivascular and granular inclusions identified only with the N-terminal antibody throughout the brain; Cluster-2 had scant TATs in limbic regions and Cluster-3 mild-moderate TATs and mild-moderate neuronal cytoplasmic inclusions and dystrophic neurites throughout the brain and moderate fine neurites. Only 17% of cluster 1 cases had the (protective) haplotype and 83% had hippocampal sclerosis. Both features differed across clusters (p=0.03 & p=0.01). TATs have molecular characteristics, distribution and burden, and genetic and pathologic associations like FTLD-TDP lesions.
TAR DNA结合蛋白43(TDP - 43)病理学是额颞叶变性(FTLD)的一个决定性特征。在FTLD - TDP中,形态独特的TDP - 43免疫反应性包涵体在全脑分布,负担为中度到高度。在阿尔茨海默病(AD)中,也观察到类似的TDP - 43免疫反应性包涵体。然而,在AD中存在一种与神经原纤维缠结相关的TDP - 43(TATs)的独特现象,即TDP - 43与神经原纤维缠结相互交织。关于TATs的特征和分布,或者TATs的负担和分布与在AD中观察到的其他FTLD - TDP样病变的负担和分布相比情况如何,人们知之甚少。在这里,我们描述了TATs的分子片段特征、负担和分布,并评估这些特征与其他TDP - 43病变的特征相比情况如何。我们在20例高概率AD病例中,使用抗磷酸化、C端和N端TDP - 43抗体进行TDP - 43免疫组化,并对五个脑区(内嗅皮质、海马下托、海马CA1和齿状回、枕颞叶皮质)内七种包涵体类型的半定量负担进行了评估。采用层次聚类分析来分析由75种不同神经病理学特征组合组成的数据集。TATs呈非球形,染色模式不均一,除海马齿状回外所有区域均有存在。所有三种抗体都能检测到TATs,尽管N端抗体的敏感性较低。确定了三个聚类:聚类1有轻度至中度的TATs、中度至频繁的神经元胞质包涵体、营养不良性神经突、神经元核内包涵体和细神经突,以及仅用N端抗体在全脑识别出的血管周围和颗粒状包涵体;聚类2在边缘区域有少量TATs;聚类3在全脑有轻度至中度的TATs、轻度至中度的神经元胞质包涵体和营养不良性神经突以及中度细神经突。聚类1中只有17%的病例具有(保护性)单倍型,83%有海马硬化。这两个特征在不同聚类间存在差异(p = 0.03和p = 0.01)。TATs具有分子特征、分布和负担,以及与FTLD - TDP病变类似的遗传和病理关联。